A. Dyspnea B. Wheezing C. Fast breathing D. Chest indrawing
Answer: (D) Chest indrawing
In IMCI, chest indrawing is used as the positive sign of dyspnea, indicating severe pneumonia.
99. Using IMCI guidelines, you classify a child as having severe pneumonia. What is the best management for the child?
A. Prescribe an antibiotic.
B. Refer him urgently to the hospital.
C. Instruct the mother to increase fluid intake.
D. Instruct the mother to continue breastfeeding.
Answer: (B) Refer him urgently to the hospital.
Severe pneumonia requires urgent referral to a hospital. Answers A, C and D are done for a client classified as having pneumonia.
100. A 5-month old infant was brought by his mother to the health center because of diarrhea occurring 4 to 5 times a day. His skin goes back slowly after a skin pinch and his eyes are sunken. Using the IMCI guidelines, you will classify this infant in which category?
A. No signs of dehydration B. Some dehydration C. Severe dehydration D. The data is insufficient.
Answer: (B) Some dehydration
Using the assessment guidelines of IMCI, a child (2 months to 5 years old) with diarrhea is classified as having SOME DEHYDRATION if he shows 2 or more of the following signs: restless or irritable, sunken eyes, the skin goes back slow after a skin pinch.
101. Based on assessment, you classified a 3-month old infant with the chief complaint of diarrhea in the category of SOME DEHYDRATION.
Based on IMCI management guidelines, which of the following will you do?
A. Bring the infant to the nearest facility where IV fluids can be given.
B. Supervise the mother in giving 200 to 400 ml. of Oresol in 4 hours.
C. Give the infant’s mother instructions on home management.
D. Keep the infant in your health center for close observation.
Answer: (B) Supervise the mother in giving 200 to 400 ml. of Oresol in 4 hours.
In the IMCI management guidelines, SOME DEHYDRATION is treated with the administration of Oresol within a period of 4 hours. The amount of Oresol is best computed on the basis of the child’s weight (75 ml/kg body weight). If the
weight is unknown, the amount of Oresol is based on the child’s age.
102. A mother is using Oresol in the management of diarrhea of her 3-year old child. She asked you what to do if her child vomits. You will tell her to
A. Bring the child to the nearest hospital for further assessment.
B. Bring the child to the health center for intravenous fluid therapy.
C. Bring the child to the health center for assessment by the physician.
D. Let the child rest for 10 minutes then continue giving Oresol more slowly.
Answer: (D) Let the child rest for 10 minutes then continue giving Oresol more slowly.
If the child vomits persistently, that is, he vomits everything that he takes in, he has to be referred urgently to a hospital. Otherwise, vomiting is managed by letting the child rest for 10 minutes and then continuing with Oresol
administration. Teach the mother to give Oresol more slowly.
103. A 1 ½ year old child was classified as having 3rd degree protein energy malnutrition, kwashiorkor. Which of the following signs will be most apparent in this child?
A. Voracious appetite B. Wasting
C. Apathy D. Edema
Answer: (D) Edema
Edema, a major sign of kwashiorkor, is caused by decreased colloidal osmotic pressure of the blood brought about by hypoalbuminemia. Decreased blood albumin level is due a protein-deficient diet.
104. Assessment of a 2-year old child revealed “baggy pants”. Using the IMCI guidelines, how will you manage this child?
A. Refer the child urgently to a hospital for confinement.
B. Coordinate with the social worker to enroll the child in a feeding program.
C. Make a teaching plan for the mother, focusing on menu planning for her child.
D. Assess and treat the child for health problems like infections and intestinal parasitism.
Answer: (A) Refer the child urgently to a hospital for confinement.
“Baggy pants” is a sign of severe marasmus. The best management is urgent referral to a hospital.
105. During the physical examination of a young child, what is the earliest sign of xerophthalmia that you may observe?
A. Keratomalacia B. Corneal opacity C. Night blindness D. Conjunctival xerosis
Answer: (D) Conjunctival xerosis
The earliest sign of Vitamin A deficiency (xerophthalmia) is night blindness.
However, this is a functional change, which is not observable during physical examination.The earliest visible lesion is conjunctival xerosis or dullness of the conjunctiva due to inadequate tear production.
106. To prevent xerophthalmia, young children are given Retinol capsule every 6 months. What is the dose given to preschoolers?
A. 10,000 IU B. 20,000 IU C. 100,000 IU D. 200,000 IU
Answer: (D) 200,000 IU
Preschoolers are given Retinol 200,000 IU every 6 months. 100,000 IU is given once to infants aged 6 to 12 months. The dose for pregnant women is 10,000 IU.
107. The major sign of iron deficiency anemia is pallor. What part is best examined for pallor?
A. Palms B. Nailbeds
C. Around the lips
D. Lower conjunctival sac
Answer: (A) Palms
The anatomic characteristics of the palms allow a reliable and convenient basis for examination for pallor.
108. Food fortification is one of the strategies to prevent micronutrient deficiency conditions. R.A. 8976 mandates fortification of certain food items. Which of the following is among these food items?
A. Sugar B. Bread
C. Margarine D. Filled milk
Answer: (A) Sugar
R.A. 8976 mandates fortification of rice, wheat flour, sugar and cooking oil with Vitamin A, iron and/or iodine.
109. What is the best course of action when there is a measles epidemic in a nearby municipality?
A. Give measles vaccine to babies aged 6 to 8 months.
B. Give babies aged 6 to 11 months one dose of 100,000 I.U. of Retinol C. Instruct mothers to keep their babies at home to prevent disease transmission.
D. Instruct mothers to feed their babies adequately to enhance their babies’
resistance.
Answer: (A) Give measles vaccine to babies aged 6 to 8 months.
Ordinarily, measles vaccine is given at 9 months of age. During an impending epidemic, however, one dose may be given to babies aged 6 to 8 months. The mother is instructed that the baby needs another dose when the baby is 9 months old.
110. A mother brought her daughter, 4 years old, to the RHU because of cough and colds. Following the IMCI assessment guide, which of the following is a danger sign that indicates the need for urgent referral to a hospital?
A. Inability to drink B. High grade fever
C. Signs of severe dehydration D. Cough for more than 30 days
Answer: (A) Inability to drink
A sick child aged 2 months to 5 years must be referred urgently to a hospital if he/she has one or more of the following signs: not able to feed or drink, vomits everything, convulsions, abnormally sleepy or difficult to awaken.
111. Management of a child with measles includes the administration of which of the following?
A. Gentian violet on mouth lesions B. Antibiotics to prevent pneumonia
C. Tetracycline eye ointment for corneal opacity
D. Retinol capsule regardless of when the last dose was given
Answer: (D) Retinol capsule regardless of when the last dose was given
An infant 6 to 12 months classified as a case of measles is given Retinol 100,000 IU; a child is given 200,000 IU regardless of when the last dose was given.
112. A mother brought her 10 month old infant for consultation because of fever, which started 4 days prior to consultation. To determine
malaria risk, what will you do?
A. Do a tourniquet test.
B. Ask where the family resides.
C. Get a specimen for blood smear.
D. Ask if the fever is present everyday.
Answer: (B) Ask where the family resides.
Because malaria is endemic, the first question to determine malaria risk is where the client’s family resides. If the area of residence is not a known endemic area, ask if the child had traveled within the past 6 months, where he/she was brought and whether he/she stayed overnight in that area.
113. The following are strategies implemented by the Department of Health to prevent mosquito-borne diseases. Which of these is most effective in the control of Dengue fever?
A. Stream seeding with larva-eating fish B. Destroying breeding places of mosquitoes
C. Chemoprophylaxis of non-immune persons going to endemic areas
D. Teaching people in endemic areas to use chemically treated mosquito nets
Answer: (B) Destroying breeding places of mosquitoes
Aedes aegypti, the vector of Dengue fever, breeds in stagnant, clear water. Its feeding time is usually during the daytime. It has a cyclical pattern of
occurrence, unlike malaria which is endemic in certain parts of the country.
114. Secondary prevention for malaria includes A. Planting of neem or eucalyptus trees
B. Residual spraying of insecticides at night
C. Determining whether a place is endemic or not
D. Growing larva-eating fish in mosquito breeding places
Answer: (C) Determining whether a place is endemic or not
This is diagnostic and therefore secondary level prevention. The other choices are for primary prevention.
115. Scotch tape swab is done to check for which intestinal parasite?
A. Ascaris B. Pinworm C. Hookworm D. Schistosoma
Answer: (B) Pinworm
Pinworm ova are deposited around the anal orifice.
116. Which of the following signs indicates the need for sputum examination for AFB?
A. Hematemesis B. Fever for 1 week C. Cough for 3 weeks D. Chest pain for 1 week
Answer: (C) Cough for 3 weeks
A client is considered a PTB suspect when he has cough for 2 weeks or more, plus one or more of the following signs: fever for 1 month or more; chest pain lasting for 2 weeks or more not attributed to other conditions; progressive, unexplained weight loss; night sweats; and hemoptysis.
117. Which clients are considered targets for DOTS Category I?
A. Sputum negative cavitary cases B. Clients returning after a default
C. Relapses and failures of previous PTB treatment regimens
D. Clients diagnosed for the first time through a positive sputum exam
Answer: (D) Clients diagnosed for the first time through a positive sputum exam Category I is for new clients diagnosed by sputum examination and clients
diagnosed to have a serious form of extrapulmonary tuberculosis, such as TB osteomyelitis.
118. To improve compliance to treatment, what innovation is being implemented in DOTS?
A. Having the health worker follow up the client at home
B. Having the health worker or a responsible family member monitor drug intake C. Having the patient come to the health center every month to get his
medications
D. Having a target list to check on whether the patient has collected his monthly supply of drugs
Answer: (B) Having the health worker or a responsible family member monitor drug intake
Directly Observed Treatment Short Course is so-called because a treatment partner, preferably a health worker accessible to the client, monitors the client’s compliance to the treatment.
119. Diagnosis of leprosy is highly dependent on recognition of symptoms. Which of the following is an early sign of leprosy?
A. Macular lesions
B. Inability to close eyelids C. Thickened painful nerves D. Sinking of the nosebridge
Answer: (C) Thickened painful nerves
The lesion of leprosy is not macular. It is characterized by a change in skin color (either reddish or whitish) and loss of sensation, sweating and hair growth over the lesion. Inability to close the eyelids (lagophthalmos) and sinking of the nosebridge are late symptoms.
120. Which of the following clients should be classified as a case of multibacillary leprosy?
A. 3 skin lesions, negative slit skin smear B. 3 skin lesions, positive slit skin smear C. 5 skin lesions, negative slit skin smear D. 5 skin lesions, positive slit skin smear
Answer: (D) 5 skin lesions, positive slit skin smear
A multibacillary leprosy case is one who has a positive slit skin smear and at least 5 skin lesions.
121. In the Philippines, which condition is the most frequent cause of death associated with schistosomiasis?
A. Liver cancer B. Liver cirrhosis C. Bladder cancer
D. Intestinal perforation
Answer: (B) Liver cirrhosis
The etiologic agent of schistosomiasis in the Philippines is Schistosoma japonicum, which affects the small intestine and the liver. Liver damage is a consequence of fibrotic reactions to schistosoma eggs in the liver.
122. What is the most effective way of controlling schistosomiasis in an endemic area?
A. Use of molluscicides B. Building of foot bridges C. Proper use of sanitary toilets
D. Use of protective footwear, such as rubber boots
Answer: (C) Proper use of sanitary toilets
The ova of the parasite get out of the human body together with feces. Cutting the cycle at this stage is the most effective way of preventing the spread of the disease to susceptible hosts.
123. When residents obtain water from an artesian well in the neighborhood, the level of this approved type of water facility is
A. I B. II C. III D. IV
Answer: (B) II
A communal faucet or water standpost is classified as Level II.
124. For prevention of hepatitis A, you decided to conduct health education activities. Which of the following is IRRELEVANT?
A. Use of sterile syringes and needles
B. Safe food preparation and food handling by vendors C. Proper disposal of human excreta and personal hygiene
D. Immediate reporting of water pipe leaks and illegal water connections
Answer: (A) Use of sterile syringes and needles
Hepatitis A is transmitted through the fecal oral route. Hepatitis B is transmitted through infected body secretions like blood and semen.
126. Which biological used in Expanded Program on Immunization (EPI) should NOT be stored in the freezer?
A. DPT
B. Oral polio vaccine C. Measles vaccine D. MMR
Answer: (A) DPT
DPT is sensitive to freezing. The appropriate storage temperature of DPT is 2 to 8° C only. OPV and measles vaccine are highly sensitive to heat and require freezing. MMR is not an immunization in the Expanded Program on
Immunization.
127. You will conduct outreach immunization in a barangay with a population of about 1500. Estimate the number of infants in the barangay.
A. 45 B. 50 C. 55 D. 60
Answer: (A) 45
To estimate the number of infants, multiply total population by 3%.
128. In Integrated Management of Childhood Illness, severe conditions generally require urgent referral to a hospital. Which of the following severe conditions DOES NOT always require urgent referral to a
hospital?
A. Mastoiditis
B. Severe dehydration C. Severe pneumonia D. Severe febrile disease
Answer: (B) Severe dehydration
The order of priority in the management of severe dehydration is as follows:
intravenous fluid therapy, referral to a facility where IV fluids can be initiated within 30 minutes, Oresol/nasogastric tube, Oresol/orem. When the foregoing measures are not possible or effective, tehn urgent referral to the hospital is done.
129. A client was diagnosed as having Dengue fever. You will say that there is slow capillary refill when the color of the nailbed that you pressed does not return within how many seconds?
A. 3 B. 5 C. 8 D. 10
Answer: (A) 3
Adequate blood supply to the area allows the return of the color of the nailbed within 3 seconds.
130. A 3-year old child was brought by his mother to the health center because of fever of 4-day duration. The child had a positive tourniquet test result. In the absence of other signs, which is the most appropriate measure that the PHN may carry out to prevent Dengue shock
syndrome?
A. Insert an NGT and give fluids per NGT.
B. Instruct the mother to give the child Oresol.
C. Start the patient on intravenous fluids STAT.
D. Refer the client to the physician for appropriate management.
Answer: (B) Instruct the mother to give the child Oresol.
Since the child does not manifest any other danger sign, maintenance of fluid balance and replacement of fluid loss may be done by giving the client Oresol.
131. The pathognomonic sign of measles is Koplik’s spot. You may see Koplik’s spot by inspecting the _____.
A. Nasal mucosa B. Buccal mucosa
C. Skin on the abdomen
D. Skin on the antecubital surface
Answer: (B) Buccal mucosa
Koplik’s spot may be seen on the mucosa of the mouth or the throat.
132. Among the following diseases, which is airborne?
A. Viral conjunctivitis B. Acute poliomyelitis C. Diphtheria
D. Measles
Answer: (D) Measles
Viral conjunctivitis is transmitted by direct or indirect contact with discharges from infected eyes. Acute poliomyelitis is spread through the fecal-oral route and contact with throat secretions, whereas diphtheria is through direct and indirect contact with respiratory secretions.
133. Among children aged 2 months to 3 years, the most prevalent form of meningitis is caused by which microorganism?
A. Hemophilus influenzae B. Morbillivirus
C. Steptococcus pneumoniae D. Neisseria meningitidis
Answer: (A) Hemophilus influenzae
Hemophilus meningitis is unusual over the age of 5 years. In developing countries, the peak incidence is in children less than 6 months of age.
Morbillivirus is the etiology of measles. Streptococcus pneumoniae and Neisseria meningitidis may cause meningitis, but age distribution is not specific in young children.
134. Human beings are the major reservoir of malaria. Which of the following strategies in malaria control is based on this fact?
A. Stream seeding B. Stream clearing
C. Destruction of breeding places D. Zooprophylaxis
Answer: (D) Zooprophylaxis
Zooprophylaxis is done by putting animals like cattle or dogs close to windows or doorways just before nightfall. The Anopheles mosquito takes his blood meal from the animal and goes back to its breeding place, thereby preventing infection of humans.
135. The use of larvivorous fish in malaria control is the basis for which strategy of malaria control?
A. Stream seeding B. Stream clearing
C. Destruction of breeding places D. Zooprophylaxis
Answer: (A) Stream seeding
Stream seeding is done by putting tilapia fry in streams or other bodies of water identified as breeding places of the Anopheles mosquito
136. Mosquito-borne diseases are prevented mostly with the use of mosquito control measures. Which of the following is NOT appropriate for malaria control?
A. Use of chemically treated mosquito nets
B. Seeding of breeding places with larva-eating fish C. Destruction of breeding places of the mosquito vector
D. Use of mosquito-repelling soaps, such as those with basil or citronella
Answer: (C) Destruction of breeding places of the mosquito vector
Anopheles mosquitoes breed in slow-moving, clear water, such as mountain streams.
137. A 4-year old client was brought to the health center with the chief complaint of severe diarrhea and the passage of “rice water” stools. The client is most probably suffering from which condition?
A. Giardiasis B. Cholera C. Amebiasis D. Dysentery
Answer: (B) Cholera
Passage of profuse watery stools is the major symptom of cholera. Both amebic and bacillary dysentery are characterized by the presence of blood and/or mucus in the stools. Giardiasis is characterized by fat malabsorption and, therefore, steatorrhea.
138. In the Philippines, which specie of schistosoma is endemic in certain regions?
A. S. mansoni B. S. japonicum C. S. malayensis D. S. haematobium
Answer: (B) S. japonicum
S. mansoni is found mostly in Africa and South America; S. haematobium in Africa and the Middle East; and S. malayensis only in peninsular Malaysia.
139. A 32-year old client came for consultation at the health center with the chief complaint of fever for a week. Accompanying symptoms were muscle pains and body malaise. A week after the start of fever, the client noted yellowish discoloration of his sclera. History showed that he
waded in flood waters about 2 weeks before the onset of symptoms.
Based on his history, which disease condition will you suspect?
A. Hepatitis A B. Hepatitis B C. Tetanus D. Leptospirosis
Answer: (D) Leptospirosis
Leptospirosis is transmitted through contact with the skin or mucous membrane with water or moist soil contaminated with urine of infected animals, like rats.
140. MWSS provides water to Manila and other cities in Metro Manila.
This is an example of which level of water facility?
A. I B. II C. III D. IV
Answer: (C) III
Waterworks systems, such as MWSS, are classified as level III.
141. You are the PHN in the city health center. A client underwent
screening for AIDS using ELISA. His result was positive. What is the best course of action that you may take?
A. Get a thorough history of the client, focusing on the practice of high risk behaviors.
B. Ask the client to be accompanied by a significant person before revealing the
B. Ask the client to be accompanied by a significant person before revealing the